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BiPAP in early guillain-barré syndrome may fail
Eelco F M Wijdicks1, Tuhin K Roy
1Department of Neurology, Division of Critical Care Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. wijde@mayo.edu
Background:
Non-invasive mechanical ventilation (BiPAP) has been introduced for use in neuromuscular respiratory disease such as amyotrophic lateral sclerosis and myasthenia gravis. There is no experience in Guillain-Barré syndrome.
Methods:
We describe for the first time the use of BiPAP to assist in the work of breathing in two consecutive patients with progressing Guillain-Barré syndrome (GBS) and marginal pulmonary function.
Results:
Our initial attempts to use BiPAP in GBS and early neuromuscular respiratory failure were totally unsuccessful. There was marked initial improvement; however, emergency intubation was needed in both patients, one of which became acutely cyanotic.
Conclusions:
Until more experience is available, we strongly warn against using BiPAP in deteriorating patients with GBS.
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Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...